Every Saturday, The CSPH highlights news or recent research in the field of human sexuality. This week, we’re discussing a new study that explores the relationship between pain and anal play in heterosexual females.

Recent studies have shown an increase in “anal eroticism” among heterosexual couples; for example, a 2010 study by Debby Herbenick found that 40% of women 20-24 years of age reported experiences with anal sex, compared to 24% reported in the early 1990s. Despite this apparent rise in anal popularity, most studies on anal play have focused on men having sex with men (MSM) populations, and few have investigated pain during anal intercourse. This study, published in the Journal of Sex and Marital Therapy, appears to be the first to explore painful anal experiences in heterosexual females. Furthermore, it attempts to define an emerging medical diagnosis of “anodyspareunia,” or severe and frequent pain during anal intercourse.

Study participants—2002 females, ages 18-30—were recruited online through Croatian universities, and information was collected through an anonymous online questionnaire. The 151-item survey included questions on sociodemographic characteristics, sexual behaviors, satisfaction, porn use, and body image. In order to collect data on anal sex experiences, researchers also included questions on first attempts at anal intercourse, frequency of anal sex, as well as levels and frequency of pain. Participants were also asked to identify causes of pain, having been offered choices such as “insufficient arousal” and “inability to relax.” Those who stated experiencing unbearable or strong pain during every instance of intercourse were classified as “anodyspareunic.”

Of the 2002 women, nearly two-thirds of participants reported any experience with anal intercourse. The prevalence of pain during these experiences was notable: nearly half of participants said that their first anal intercourse was too painful to continue. Moreover, 9% of participants who had anal sex in the past year reported experiencing severe pain during every intercourse. This 9% were classified as having anodyspareunia, with many also reporting unchanging levels of pain over time.

So what could be behind these statistics? Some researchers believe that the presence of anodyspareunia and severe pain is less a medical diagnosis and more a symptom of lack of proper education and information around anal pleasure. For some participants in the study, this may certainly be true as the overwhelming majority of participants cited “inability to relax” as the main source of pain. Relaxation is key in any kind of anal play, as the internal and external muscles of the anal sphincter can tense up in response to stress, making penetration difficult and painful.

While the study shows that relaxation is connected to painful experiences, it doesn’t fully address why or how the participants were unable to relax. For example, the study failed to gauge if participants had proper stimulation when engaging in anal play. Clitoral and/or vaginal stimulation helps ease tension in the anal muscles, and anal foreplay (with fingers, toys, etc.) is often a necessary warm-up for intercourse, especially for first-time anal players. Another important factor in relaxation and prep is partner experience and communication. The study reports that participants who were experiencing chronic pain were less sexually assertive, and that about 17% of those who experienced pain did not stop their partner. This brings up even more questions about how open communication was with partners—were participants nervous about pleasing their partners? Did they have undesirable past experiences that made them more nervous? These anxieties could all lead to unconscious stress and tension in the body that makes anal sex much less pleasurable.

The role of lubricant is also vital; along with “inability to relax,” “improper lubrication” was another widely cited cause of painful intercourse. One reason for “improper lubrication” is lack of education around using lube during anal play. In fact, over half of participants (52%) reported not using lube during their first anal experience, an interesting statistic when considering that 49% of participants reported very painful first experiences, pointing to a knowledge gap in lubricant use and stimulation. Additionally, the study does not address how much and what kinds of lubricant were used, and if this had any effect on pain.

Overall, the fact that participants cited factors such as preparation, lubrication, and relaxation as major causes of pain is representative of the need for greater access to non-judgemental education on anal pleasure. Given the taboo that the anus holds in our society as a “forbidden” pleasure-zone, it is easy for people to have no information, or lots of mis-information, about how to safely and enjoyably experience anal play. Misconceptions, such as “anal sex is supposed to hurt,” can also contribute to the shame and anxiety that hinder open communication with partners and add extra mental and physical stress.

Along with more education on the topic, this study also demonstrates a need for more research on the physiology behind pain. The study authors note that the 9% figure of participants suffering chronic pain is similar to figures claiming that 10% of people experience pelvic pain during vaginal intercourse. Pain in the pelvic floor could cause additional discomfort and pain during anal penetration, and can provide an explanation for sensitivity even after using loads of lube, communication, and prep. Other anal health issues, such as hemorrhoids, are also potential sources of discomfort, yet none of these factors have been scientifically or clinically studied in relation to anal sex.

Although anal play, like any other sexual practice, has its fair share of risks and complications, it can also be a highly pleasurable activity for many. Yet it is only through increased awareness and more thorough research that we can decrease stigma and make this pleasure accessible to all who’d like to play!

To read the full study, click here. For more on the topic, check out Charlie Glickman’s analysis.